This week marks the one-year anniversary of the passage of health care reform- the Affordable Care Act – and what a difference a year makes in many states as they work to implement the federal law.
Since March 2010 states have begun planning to implement purchasing mechanisms called Health Insurance Exchanges for individuals and small businesses to utilize to purchase qualified health plans.
According to the Washington Post, some states have moved dramatically to implement mechanisms to improve health care access such as Minnesota, Connecticut and Washington, D.C. These jurisdictions have utilized the increase in federal dollars to expand coverage of childless adults. A much bolder approach has been embraced by Vermont which is exploring a single-payer health care system that would phase out most private insurance. That option was ruled out of the federal health care debate by candidate Obama prior to his election in November 2008.Meanwhile Oregon’s health care reform effort is focusing on preventive care and providing proven treatments.
But in states like Washington , Wisconsin implementation of the Affordable Care Act has taken a different route with a hairpin turn in the road after the 2010 mid-term elections.
Washington
Since 2006 a committee of 11 physicians, the state's Health Technology Assessment program, has made decisions on what specific medical procedures should be covered for about 750,000 state residents including state employees, Medicaid recipients and prisoners, according to the Wall Street Journal. “Washington is a leader in attempting to bend the cost curve while improving quality," said Anne Gauthier, senior program director at the National Academy for State Health Policy, a nonpartisan think tank that isn't involved with the Washington program. "[Cost] is something that has been very difficult to bring into coverage decisions," Ms. Gauthier said.
Because of this committee’s work, Washington is being watched very closely nationally as states grapple with Medicaid cost increases due to the economic downturn and new requirements under the Affordable Care Act. Washington’s effort to factor in health care procedure costs into its health-coverage decisions, in addition to effectiveness and safety, has led critics to argue that this analysis amounts to rationing because it can limit access for patients who need services but can't afford them.
Wisconsin
In Wisconsin, political ideology has been the primary game-changer in its effort to implement portions of the Affordable Care Act. When the governor’s mansion and both houses of the Wisconsin legislature shifted from Democratic control to leadership by Republican’s a dramatic shift in policy occurred.
Under Governor Jim Doyle, a Democrat, Affordable Care Act implementation was led by an office he created, the Office of Health Care Reform. When Doyle decided not to seek a third-term and Republican Scott Walker was elected, Walker renamed the entity the Office of Free Market Health Care. The ideological shift was on.
“We view this as a fundamentally different approach than what the past [Wisconsin] administration was doing — and what . . . the Obama administration is pushing,” Walker told the Washington Post, the government has no business influencing people’s health-care choices.
However, its important to note that Wisconsin already ranks second in health care coverage with only 6 percent of its residents lack health coverage. Over the years, under Democratic and Republican governors alike, Wisconsin repeatedly has expanded its Medicaid program, called BadgerCare, so that an unusually large share of people already has public insurance. Those distinctions are part of the Walker administration’s justification for resisting federal requirements.In implementing health insurance exchanges, Walker has said Wisconsin will create one or more exchanges to help individuals and small businesses buy insurance but based on free-market forces and not government driven as the previous Governor envisioned. Specifically, Governor Walker disagrees with the Affordable Care Act requirement that every health plan sold through an exchange must cover a list of “essential benefits” that HHS will define.
Kansas
While every major politician in Kansas is a Republican, blocking the Affordable Care Act is not on the agenda. Thanks to Sandy Praeger, Kansas' Insurance Commissioner who is working hard to make the state a leader in the implementation of the ACA. Praeger is a testament, according to < a href="www.politico.com">Politico to how much of the course of health reform’s implementation lies well outside the purview of politics and in the hands of state bureaucracy — but also how quickly a governor could move to change that.
So while other states, like California, pushed through legislation authorizing a health exchange, Praeger has moved more strategically. She plans to hold numerous meetings on health reform issues in the interim. After her first health exchange meeting in January, she will host in March a meeting on whether the state ought to apply for a waiver from the MLR regulation. Concurrently, Praeger has quietly applied for every health reform grant related to insurance, meaning the vast majority of Kansas’s implementation moves through her office.
Arizona
In Arizona, Governor Brewer, recently submitted a proposal to the U.S. Department of Health and Human Services to waive the Affordable Care Act Maintenance of Effort requirements. The Medicaid MOE provision in the Affordable Care Act generally ensures that States’ eligibility rules for adults under the Medicaid program remain in place pending implementation of eligibility rules changes that become effective in January 2014. The MOE provision for children extends to 2019.
In addition, the Arizona Senate Appropriations Committee, on February 23, voted to eliminate the Arizona Health Care Cost Containment System (e.g., the state’s Medicaid program which is primarily operated under a Section 1115 waiver) and replace it with a different health care coverage arrangement.
